Table 2.
Dose and schedule of systemic chemotherapy and glucocorticoids administered.
| Treatment schedule (days) | Chemotherapy agent/dose/route (Glucocorticoid/ dose/route/frequency) | Clinical systemic response | Clinical CNS response |
|---|---|---|---|
| 0 | •Cytarabine arabinoside 300 mg/m2 IV infusion over 24 h •L-asparaginase 10,000 IU/m2 IM (Prednisolone 1 mg/kg PO q24h) | PD | PR |
| 7 | •Vincristine 0.7 mg/m2 IV (Prednisolone 1 mg/kg PO q24h) | CR | PR |
| 14 | •Lomustine 65 mg/m2 PO (Prednisolone 0.5 mg/kg PO q24h) | PD | CR |
| 21 | •(Prednisolone 0.5 mg/kg PO q24h) | ||
| 28 | •Vincristine 0.7 mg/m2 IV (Prednisolone 1 mg/kg PO q24h) | PR* | CR |
| 35 | •Cyclophosphamide 200 mg/m2 PO (Prednisolone 1 mg/kg PO q24h) | PR* | PD |
| 42 | •Intrathecal chemotherapy: Methotrexate 2.5 mg and Cytarabine arabinoside 100 mg (Dexamethasone 0.2 mg/kg IV q24h, IV in clinic and PO after discharge) | CR | |
| 44 | •Vincristine 0.5 mg/m2 IV (Dexamethasone 0.2 mg/kg PO q24h) | CR | |
| 51 | •Doxorubicin 1 mg/kg IV (Dexamethasone 0.1 mg/kg PO q24h) | CR |
Response was assessed 7 days after treatment except for Lomustine that was 14 days after. Clinical systemic response assessed according to RECIST criteria (21) by physical examination and circulating atypical cells. Clinical systemic response - complete remission (CR), palpable peripheral lymph nodes were > 1 cm length and hematology did not show circulating atypical cells; partial remission (PR), improvement of lymph node size >30% in comparison to baseline but > 1 cm length; PR*, palpable peripheral lymph nodes > 1 cm diameter but with persistent circulating atypical cells. Progressive disease (PD), increase in size of palpable peripheral lymph nodes and/or progressive atypical cells circulating. Clinical CNS response was determined by clinical history and neurological examination. Clinical CNS response was not considered to be due to systemic chemotherapy on weeks 6 and 7 as the patient had received ITC. CNS CR, absence of neurological deficits and thoracolumbar pain. CNS PR, persistent neurological signs but improved from previous; CNS PD, progressive neurological signs.